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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Quintal on July 11, 2008, at 18:45:33
I went to see my new (NHS) psychologist today. The clinic was in the middle of a rough housing estate, all barbed wire and pointy railings. One of those rotting 1970's flat-roofed buildings. Quite depressing really. I had to fill in a ticky-box anxiety and depression questionaire while I waited, then T poked her head round the door and introduced herself.
She said she mainly deals with CBT (heart sank), but also uses other forms of therapy (okay). She asked me if I knew anything about therapy. I let her know I'd had a few sessions of CBT three years ago, but was vague about the reasons for termination. We talked about why I was there, my hospitalization last year (T screwed her face up "that doesn't sound very nice, it's like something being *done* to you" (((T))). I gave a brief history of my bipolar disorder beginning at 17 (self diagnosis), first treatment at 19, and first psychotic/manic episode at 25. Told her about dropping out of college after mother died, T made soothing noises "that must have been hard, coping with these mood swings and looking after your mother at the same time". I nodded and smiled politely. Moved on to talk about her gambling debts, spending sprees and mood swings etc.
I said I was planning to study pharmacology at univeristy and she asked what my beliefs were regarding the cause of my conditions. I said it was probably part biological, possibly hereditary probably the way things that happened to me as a child affected my developing personality and conditioned me to certain behaviours. I likened it to rickets; the brain of a child that develops without enough nourishment (dietary, environmental stimulus, emotional) may not form properly, and this may lead to an actual physical problem in the brain as an adult, as well as abnormal behavioural responses. T agreed "that is a good analogy, we are moulded by our experiences". She was relieved that despite wanting to study pharamcology, I didn't hold a purely biological theory of mental illness, T: "I had to check because it's very difficult for me to work with people like that".
We also talked about the spiritual experiences. I explained about the religious ecstacy I'd experienced despite being an atheist, and she said she had a woman with a very similar experience. Apparently it's common with bipolar disorder. She said "some people with bipolar would do anything to get rid of it, and there are others that wouldn't give it up no matter what. Which are you?" I said I wouldn't want to give it up. She probed for reasons why, and I said I guessed in my case the positive experiences must outweigh the negative esperiences enough for it to be enjoyable.
We dicussed how I cope with breakthrough psychotic symptoms (last week I heard footsteps on the stairs and someone tramping around the house while I was in bed), I said I am usually able to say "there's a small chance there really is someone in the house, but most likely I'm hallucinating". I described the meditation/mindfulness exercise I used to get myself through it, and her inner CBTist was impressed. She agreed with my outreach worker that my risk of complete relapse is fairly low.
We made an appointment for two weeks time, and then we'll start some proper therapy. She thinks therapy should have clear goals and not just be supportive (although I suspect her position might change slightly if I were actually handing her a paycheck at the end of every session instead of her getting limited government funding). I'm not sure what these goals might be, because I think what I need most is support, but I'm sure I'll come up with something. This is always the hard part. I think I'm limited to 12 sessions at the most. What realistically can anyone acheive in that? In the past I've been restricted to four hour-long sessions.
Q
Posted by Dinah on July 11, 2008, at 20:00:19
In reply to First appointment with T, posted by Quintal on July 11, 2008, at 18:45:33
Is she able to do more than twelve sessions if she can justify it?
I've heard of some brief therapies based on something other than CBT, but I haven't heard many cases of them being used. Did she say how she planned to approach it? It rather sounds as if she has a matter of fact approach. Maybe her support could come from validating the helpful ways you've learned to cope, and sharing new ones once she sees where you might need some extra help? I'm not really familiar enough with brief therapy to know for sure.
Do you feel comfortable with her, and hopeful that her approach will help? I know NHS doesn't give a lot of choice in therapists.
Posted by Phillipa on July 11, 2008, at 23:24:16
In reply to Re: First appointment with T » Quintal, posted by Dinah on July 11, 2008, at 20:00:19
Q how did you feel about the session? And did you feel like you could work with her? Any idea of goals you could set up in such a short period. And agree with Dinah could it be extended the time frame. Phillipa.
Posted by Quintal on July 14, 2008, at 6:22:07
In reply to Re: First appointment with T, posted by Phillipa on July 11, 2008, at 23:24:16
I fel very good about the session. I think I could work with her. I might ask to work on intrusive thoughts and irritability.
Q
Posted by Quintal on July 14, 2008, at 6:28:48
In reply to Re: First appointment with T » Quintal, posted by Dinah on July 11, 2008, at 20:00:19
I don't know what the limitations are for this period really. Someone mentioned 12, but I have known someone have CBT for years. Not that she shows much sign of improvement though. I suspect it's more supportive that goal-orientated in her case.
It isn't really seen as brief therapy here (even though it is by comparison). They expect you to be better after 4-12 sessions. Maybe not actually, but that's your ration and get what you're given.
I feel comfortable enough to work with her. I'm just doubtful whether you can really get to know someone well enough to help them properly in just 12 sessions, so I don't think it will really be of much benefit. I'm just doing it to keep the psychiatrist and social worker happy.
Q
Posted by Phillipa on July 14, 2008, at 19:16:58
In reply to Re: First appointment with T » Dinah, posted by Quintal on July 14, 2008, at 6:28:48
Q you never know so how bout a positive attitude about the theraphy might be surprised. Phillipa
This is the end of the thread.
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